Many health care programs, including Medicaid and Affordable Care Act (ACA) health insurance marketplaces, operate according to federal law. Using waivers, states can gain federal approval to increase their flexibility within that law.

States have long used Medicaid Section 1115 waivers to manage their Medicaid programs. The ACA introduced the State Innovation Waiver, also known as a Section 1332 waiver, which can be used to waive many health insurance marketplace requirements.

This brief outlines how Medicaid Section 1115 and ACA Section 1332 waivers work and what states should consider when designing these waivers.